The modern native and foreign literature data on the hip arthroplasty results in patients with overweight including the data on the choice of the material and method of surgical intervention, risk and rate of perioperative complications, rehabilitation results are analyzed.

BackgroundTotal knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) is considered the most effective intervention reducing knee pain and improving physical function. However, higher risk of late complication and worse surgery outcomes may be observed in patients with active disease.[1]ObjectivesTo study the knee joint function and pain before and after the TKA in patient with rheumatoid arthritis.Methods69 RA patients (10 (14,5%) males and 59 (85,5%) females) with an average age of 59 [52; 64] years were included into the study group. 81 osteoarthritis (OA) patients (38 males (46,9%) and 43(53,1%) females) aged 66 [61; 73] years, were included into the control group. 23,2% of RA patients had a highly active disease at the moment of intervention. All patients underwent cemented TKA and completed Oxford Knee score (OKS) before the surgery, after discharge and 3 and 12 months after the surgery. Knee pain was assessed using VAS score also before intervention, straight after and 3 and 12 months after the surgery. All analyses were performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA). A p value of less than 0.05 was considered statistically significant.ResultsPatients in RA group had significantly lower preoperative OKS results, than OA patients (25.0 [23.5; 27.0] versus 29.0 [26.5: 30.0], p=0.00, Mann-Whitney) as well as lower postoperative OKS results before the discharge (34.0 [34; 38] versus 40.0 [35; 40] p=0.00, Mann-Whitney). 3 months after the intervention OKS scores were comparable within the two groups (43.0 [42; 44] versus 43.0 [42; 44], p=0.557; Mann-Whitney). The same was found for OKS scores 12 months after the surgery (44.0 [44; 47] versus 44.0 [44; 47], p=0.328, Mann-Whitney). Pain intensity in RA patients varied from 60 to 90 mm according to VAS prior to surgery and was lower than among OA patients (80.0 [80; 90] versus 90.0 [80; 100], p=0.00, Mann-Whitney) which can be explained by patients’ higher pain tolerance due to “usual” pain in RA. The same tendency was observed immediately after the intervention (55.0 [50; 60] versus 65.0 [50; 65], p=0.00, Mann-Whitney). 3 months after the surgery pain intensity was similar in both groups (30.0 [30; 35], p=0.349, Mann-Whitney). 1 year after the intervention RA patients reported higher VAS scores probably due to RA activity (20.0 [20; 20] versus 10.0 [10; 15], p=0.00, Mann-Whitney).ConclusionThe effectiveness of TKA for pain reduction and improvement of knee function in patients with RA was comparable to that among patients with OA. OKS scores were lower in RA group prior to surgery, however, 3 and 12 months after the intervention they did not differ between the patients with RA and OA.Reference[1]Lee DK, Kim HJ, Cho IY, Lee DH. Infection and revision rates following primary total knee arthroplasty in patients with rheumatoid arthritis versus osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017 Dec;25(12):3800-3807. doi: 10.1007/s00167-016-4306-8. Epub 2016 Sep 7. PMID: 27605127.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundPatients with rheumatoid arthritis (RA) often require adequate disease control prior to total knee arthroplasty (TKA). At the same time, they may have worse outcomes and late complications compared to osteoarthritis (OA) patients.ObjectivesTo study the functional abilities of RA patients undergoing TKA compared to OA patients using the KSS scoring system.MethodsThe study included 150 patients: 69 patients (46%) with RA and 81 patients (54%) with OA. 32% of them were males and 68% were females. Th average age of patients with RA was 59.0 [52; 64] years, while in OA group – 66.0 [61; 73] years. Among patients with RA, 60.9% had moderately active diseases and 23.2% had highly active disease prior to intervention. All patients underwent cemented TKA. All of them also completed KSS score prior to surgery, immediately after that and 3 and 12 months after the discharge. Statistical analysis was performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA). A p value of less than 0.05 was considered statistically significant.ResultsPrior to intervention patients with RA had significantly lower KSS scores compared to OA patients (45.0 [40; 55] versus 60.0 [50; 60], p=0.00, Mann-Whitney). After the surgery KSS became comparable between the two groups (83.0 [74; 84] versus 82.0 [80.5; 85], p=0.754, Mann-Whitney). 3 months after the intervention RA patients had significantly higher KSS scores than prior to surgery (Mdn=88.0, n=69 versus Mdn=40.0, n=69, z=-7.23, p=0.00) or at discharge (Mdn=88.0, n=69 versus Mdn=83.0, n=69, z=-7.25, p=0.00, Wilcoxon test). The same trend was observed for KSS completed 12 months after the surgery (Mdn=93.0, n=69 versus Mdn=88.0 in KSS 3 months after the surgery, n=69, z=-7.26, p=0.00). At the same time, the results of KSS were comparable between RA and OA groups 3 and 12 months after the intervention (88.0 [88; 88] in RA group versus 88.0 [87; 89] in OA group, p=0.772, Mann-Whitney; 94.0 [93; 95] in RA group versus 94.0 [93;95] in OA group, p=0.702, Mann-Whitney, respectively).ConclusionThe functional abilities of patient with RA after TKA did not differ from those among OA patients regardless of diseases activity despite, despite the fact that among RA patients KSS scores were significantly lower prior to surgery. KSS scores of RA patients improved 3 and 12 months after the intervention and were comparable to OA group.Reference[1] Kumagai K, Harigane K, Kusayama Y, Tezuka T, Inaba Y, Saito T. Total knee arthroplasty improves both knee function and disease activity in patients with rheumatoid arthritis. Mod Rheumatol. 2017 Sep;27(5):806-810. doi: 10.1080/14397595.2016.1265705. Epub 2016 Dec 16. PMID: 27919194.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Orthpedics and traumatology Оригинальные исследОвания Ортопедия и травматология р евматоидный артрит (рА) представляет собой хроническое воспалительное заболевание суставов аутоиммунной природы c высоким процентом инвалидизации пациентов трудоспособного возраста [3, 6, 7]. развитие вторичного остеоартроза крупных суставов с нарушением функции нижних конечностей значительно ограничивает физическую активность и качество жиз-ни, определяя необходимость радикальных вмешательств [7]. Синовиальная оболочка при РА продуцирует множество цитокинов и хемокинов, в том числе фактор некроза опухоли α (ФНОα), вызывающих деструкцию суставного хряща; хондроциты также могут продуцировать ФНОα [10, 16]. Таким образом, воспалительный субстрат внутри сустава является источником высокой активности

Orthpedics and traumatology Оригинальные исследОвания Ортопедия и травматология р евматоидный артрит (рА) представляет собой хроническое воспалительное заболевание суставов аутоиммунной природы c высоким процентом инвалидизации пациентов трудоспособного возраста [3, 6, 7]. развитие вторичного остеоартроза крупных суставов с нарушением функции нижних конечностей значительно ограничивает физическую активность и качество жиз-ни, определяя необходимость радикальных вмешательств [7]. Синовиальная оболочка при РА продуцирует множество цитокинов и хемокинов, в том числе фактор некроза опухоли α (ФНОα), вызывающих деструкцию суставного хряща; хондроциты также могут продуцировать ФНОα [10, 16]. Таким образом, воспалительный субстрат внутри сустава является источником высокой активности